Well, have you managed to go to the pub or eat outside a restaurant yet? It depends where you live, the weather and if you could get a booking! If you have, well done, if not, sorry, but hopefully soon. Slowly we feel as though we are coming out of hibernation. Though COVID numbers remain high and will be as we test more people and we mix. However, the number of people admitted to hospital continues to drop as do deaths. Some hospitals in COVID hot spots in the Midlands and the North are still having COVID admissions everyday but in many other hospitals with no new COVID admissions there is a return to more normal working including in nuclear medicine. We must hope that with vaccination rates good, the expected 3^rd wave will not result in a large spike in either admissions or deaths.

Maybe your mind is thinking about a well-deserved break either here is the UK or maybe being brave overseas. I am sure we can allow ourselves some hope but this is a cruel and horrid disease so we must be prepared for anything. This year is mine and Mrs B’s 40^th wedding anniversary. She probably deserves a medal for putting up with me for that long but I suspect it will be a simple celebration, maybe a glass of bubbly in the garden if the weather permits as I suspect any place we would which to go will be on the red list. However, we must not be down hearted though as we got through this pandemic with our sanity and health pretty much intact and got our 2 vaccines on time.

Whilst the world has been pre-occupied with Brexit and COVID there have been advances in the world of radionuclide therapy. NICE has approved the use of Y-90 SIRT in hepatocellular cancer and an interim report of the VISION trail suggests that Lu-177 PSMA will be a life extending treatment with registration and hopefully NICE approval on the horizon. However, as I have written before we must ensure this available to ALL eligible patient’s in the UK not just those who live in the lucky post codes. This will entail all of us as the delivery of these treatments as it is a multi-craft endeavour especially with the new requirements for patient based dosimetry. To ensure this can happen ARSAC must modernise the way they look at licencing with the old methods requiring multiple visits to other hospitals providing the required service not sustainable in a COVID and post COVID world.

On the negative side a report for the “Getting It Right First Time (GIRFT)” committee of the Royal College of Radiologists has recommended that cardiac MR and CT be used in patients with chest pain as MPS was not widely available. However, this takes no account of our aging population with increasing rates of renal impairment and the lack of access to cardiac MR. This is something  I know about. The waiting list for my cardiac MR that was considered urgent was 9 months. The scan took 2 hours and required a lot of patient co-operation. I just cannot see how this can be applicable in a routine fashion in the numbers required when a gamma camera can crack through 2 MPSs an hour without breaking sweat. I proposed a better name for name for this report was “Asking Nuclear Medicine to Sort Out the Undiagnostic MR Cardiac Scan Which We Could Not Do Anyway Because of the Patient’s Renal Impairment” programme but I suppose “ANMSOUMRCWWCNABPNI” does not sound as snappy as “GIRFT”

So as spring progressives, the weather warms and we can get out more, visit our loved ones and friends. Maybe share a coffee or a pint of beer or a meal with those we have separated from for the past 6 months let us start to look forwards to what we can do to enhance our nuclear medicine practice in the months ahead.

Dr John Buscombe

BNMS President